MedicaidBilling CodesHigh impact
[Ohio] Requirements for Including National Drug Code
CareSource·OH · Pharmacy, Oncology, Infectious Disease +2 more·Pharmacy
Effective date
Jul 25, 2025
We identified it
May 9, 2026
Summary
Ohio Medicaid now requires National Drug Codes (NDC) to be included in the LIN segment of 837 claims for specific HCPCS and CPT drug codes (B4164-B4240, J0120-J9999, Q0138-Q9999, S0145-S5001, CPT 90281-90399). Notably, Q4100-Q4499 skin substitutes and RSV vaccine codes 90380-90381 are EXCLUDED from NDC requirements. The CTP segment must also be used for J-series, B-series, Q-series, and S-series drug codes.
Action Required
By July 25, 2025: Billing team must update the 837 claim submission process in billing software to automatically include NDC codes in the LIN segment (2410 loop) for all B4164-B4240, J0120-J9999, Q0138-Q9999, S0145-S5001, and CPT 90281-90399 codes. Ensure CTP segment is populated with drug quantity and NDC count for J-series, B-series, Q-series, and S-series drug codes. Configure system to EXCLUDE NDC requirement for Q4100-Q4499 (skin substitutes) and RSV vaccine CPT codes 90380 and 90381. Verify compliance in billing system testing before the effective date. Non-compliance will result in claim denials or post-adjudication issues. Assign pharmacy billing staff to monitor quarterly ODM CPT/HCPCS code updates on the ODM Companion Guides website.